Reflections on the Voluntary Sector, Social Enterprise and the NHS
Posted On 2011-07-29 08:41:26 By David CrookHaving spent the last four months working with a charitable organisation and following the government's drive to diversify provision of service, I thought it would be interesting to reflect on some of the differences I've noted in the ways these organisations operate.
In particular, having worked in health informatics for over 20 years now, during which time I and many others have banged the drum that we need to focus on outcomes as much as inputs when managing a service, it seems particularly pertinent to look at this.
From my, allbeit limited, experience there are marked differences in the way in which the voluntary sector needs to operate, they have to be much more market aware. Everything they do has an impact on their ability to raise funds, which is the life blood of the organisation. There is tremendous drive to be able to demonstrate the impact that their services are having and for them to be able to reach out to their stakeholders - whether they are beneficiaries of the charities aims or whether they are supporters of the charity themselves.
The particular charity with which I have been working, are highly focussed on developing the way in which they can assess the impact that they have, or in health service terms the outcomes that they achieve. They are also highly focussed in trying to make sure that they make the best use of digital technologies to fully engage with their stakeholders.
In the health service, though there is enthusiasm in both of these areas, the same level of drive is not there. Whilst payment by results (Pbr), which focusses on inputs remains, there is limited incentive to look at achieving good outcomes. This is especially so where healthcare is delivered across pathways that are broader than the HRG.
Healthcare is complicated, many conditions and the outcomes associated with them are varied, but it doesn't prevent people using their ingenuity to look at data that already exists to understand outcomes but there needs to be greater incentive to do this. Some of the work that I am undertaking with the National Screening Committee is being able to identify (potential) good sources of outcome data sitting across various organisations associated with the relevant pathways. The trick is to understand these information flows and put in place processes to allow that data to be captured in a meaningful way.
The governments information revolution paper looks to make the patient the centre of this revolution in the same way that the voluntary sector makes the supporters and beneficiaries that support them the centre of their communications, but until there is investment in IM&T or an incentive to do this, it is unlikely to happen. See my earlier blog on investing in the information revolution.
The last area to contrast is how social enterprises may take hold of this agenda. Again it has been interesting working with a social enterprise in the health sector to see the freedom that the lack of overbearing beauracracy and ability to innovate and make decisions gives them, it will be interesting to see whether their innovative and entrepreneurial approach allows them to push more towards a model that I've seen in the voluntary sector and focus on outcomes and communicating with patients or whether they will still be restrained by the NHS model.